Tomás: low after the redundancy

The case (fictional)

Tomás is 34. He grew up in Porto and has lived in Manchester for ten years, where he worked as a warehouse supervisor until he was made redundant four months ago. His GP refers him with "low mood, poor sleep, not coping".

He describes feeling flat most days for about three months. He has lost interest in the five-a-side football he used to love, wakes at four in the morning and cannot get back to sleep, eats less and has lost about five kilograms. He cannot concentrate on job applications and calls himself "useless" and a burden on his partner, Leah.

He used to drink at weekends. Now he has four or five cans most evenings "to switch off", sometimes more. He says the drinking started "when everything went bad", but he is vague about which came first.

Asked whether he has ever felt the opposite of low, he says no. Leah, who came with him, remembers a week three years ago when he barely slept, started two business plans, spent two thousand pounds on equipment and talked so fast that friends were worried. Tomás says it was "just a good week". His mother had "nervous breakdowns" and spent time in hospital in Portugal; he does not know her diagnosis.

He says that sometimes he thinks everyone would be better off without him, "but I'd never do anything". He has had no blood tests for several years.